Connor Green, DC
Individual provider Active NPI Chiropractor · Cave Junction, OR
NPI 1558088450 · NPPES record last updated Oct 21, 2022
Key facts
- NPI
- 1558088450
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 6253 (OR)
- Practice address
- 202 Lister St
Cave Junction, OR 97523-9047 - Phone
- (541) 592-6220
- NPI assigned
- Oct 21, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Western States College of Chiropractic, 2022
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Total Performance Sports Medicine PC
Practice addresses (Care Compare)
1328 NW 6TH St
Grants Pass, OR 97526-1255
Phone (541) 476-4010
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221128000207 | OR | Practitioner - Chiropractic | 3870961741 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6253 | OR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Total Performance Sports Medicine, PC | Chiropractor | Current |
Accepting new patients |
Locations
202 Lister St
Cave Junction, OR 97523
Phone (541) 592-6220
1328 NW 6th St
Grants Pass, OR 97526
Phone (541) 476-4010
3522 Heathrow Way
Ste 100
Medford, OR 97504
Phone (541) 200-3005
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 6253 | OR | Yes |
Addresses
Primary practice location
202 Lister St
Cave Junction, OR 97523-9047
Mailing address
PO Box 774
Grants Pass, OR 97528-0066
Phone (541) 476-4010
Other practice location 1
1328 NW 6th St
Grants Pass, OR 97526-1255
Phone (541) 476-4010
Other providers in Cave Junction, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.